OCD: Treatment approaches

There are different ways to treating OCD.

The 2005 NICE guidelines for the treatment of OCD and body dysmorphic disorder (BDD) encourage the use of a stepped-care model. The model aims to provide OCD sufferers with the least intrusive but most effective management for the patients needs. Each step provides successively greater intervention, assuming the previous step has already been implemented but has been unsuccessful. The model tailors the level of intervention to characteristics of the sufferers OCD and emphasizes the benefits of involving the family, schools and social workers.

Psychological therapy

Exposure Response Prevention (ERP) is a form of cognitive behaviour therapy (CBT) and produces response rates of 85% in subjects who complete therapy. Patients are first required to produce a hierarchy of anxiety-inducing situations. The client then faces the feared situations or objects without performing the compulsive ritual. The objective of ERP is to produce habituation, where anxiety reduces naturally after prolonged exposure to the stimulus. A reduction in anxiety is seen within 60-90 minutes if the patient does not engage in anxiolytic behaviours. The patient works through the graded hierarchy tackling the least feared challenges first.

ERP can be delivered in a variety of forms, including self-help programs such as books, computer packages and telephone therapy. These provide a self-directed approach to overcoming OCD but with some therapist input for goal identification and early education. CBT often has long waiting lists and is demanding on therapists time. Self-help approaches have the potential to help more patients with minimal input from a clinician and may be monitored at the primary care level.

Psychological interventions for children with OCD follow similar principles as adult-based therapies. It is important to acknowledge developmental discrepancies and language ability in children. Significant emphasis should also be placed on involvement of the family.

Pharmacological therapies

Clomipramine and the Selective Serotonin Reuptake Inhibitors (SSRIs) are the most effective drugs in the treatment of OCD. This is due to their ability to specifically inhibit the synaptic reuptake of serotonin. Advice on prescribing for OCD